Post-Stroke Pain Meets Deep Brain Stimulation.

Post-stroke chronic pain is the focus of new research by Cleveland Clinic researchers. The researchers engage in the first prospective, randomized, and controlled trial examining the effects of deep brain stimulation (DBS) to address pain in patients with post-stroke pain syndrome. Their approach departed from an analgesia-based approach and focused instead on the neural networks relating to the control of emotion and behavior. They believed that “modulating the postaffective sphere of pain would improve quality of life or relieve pain-related disability, with or without attenuation of pain intensity.” They studied 10 Cleveland Clinic patients with longstanding post-stroke pain syndrome. Post-stroke pain syndrome is associated with severe, refractory pain, so that patients with this syndrome are in need of therapies to alleviate suffering and disability. Moreover, they have complete or near-complete damage to the sensory-discriminative pathways. The study results suggest that neuromodulation therapies should focus on reducing pain-related suffering or disability rather than pain intensity, shifting surgical targeting away from neural networks underlying the sensory-discriminative domain toward the networks that mediate the affective-motivational sphere of chronic pain. The researchers plan to expand the research to include patients with other types of chronic pain.